AB0690 SUBCLINICAL JOINT INVOLVEMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS: ROLE OF ULTRASOUND EVALUATION
Authors: L. M. Argolini, O. De Lucia, C. Artusi, A. Amati, C. Iannone, I. Magi, G. Cincinelli, M. Gerosa, R. Caporali
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Patients with Systemic lupus erythematosus (SLE) experience musculoskeletal involvement in up to 90% of cases. Clinical presentation includes arthralgia, non-erosive arthritis, erosive arthritis and Jaccoud's arthropathy [1]. Recently, thanks to the use of ultrasound (US), several studies have demonstrated the presence of a subclinical joint and peri-articular inflammatory state, especially in patients with non-specific symptoms [2]. However, studies involved a small number of patients and there is a lack of predictive factors of disease progression to more aggressive forms as well of specific and validated clinimetric indices in patients with SLE. <h3>Objectives</h3> To evaluate joint and peri-articular involvement in SLE patients with different patter of musculoskeletal involvement by US. To evaluate the strength of the clinimetric indices already validated in other rheumatologic diseases (DAS28, CDAI, SDAI) in patients with SLE. To analyse the predictive value of laboratory data (autoantibody profile, complement levels, acute phase reactants) in joint involvement. <h3>Methods</h3> Consecutive SLE patients (18-65 years old), who fulfilled the EULAR/ACR 2019 criteria, were enrolled: 20 without symptomatic musculoskeletal involvement (Group 1) 19 with arthralgias without structural joint alterations (Group 2), 11 patients with estabilshed musculoskeletal involvement (Group 3). All patients undergo ultrasound evaluation with Esaote MyLab70 device with a 6-18 mmHz linear probe; wrists, metacarpophalangeal and proximal interphalangea joints, all finger flexors, wrist extensors and flexors at the hands, elbows, long head of the biceps and Achilles tendon were evaluated. All abnormalities were defined according to OMERACT EULAR Score System. [9]. DAS28 CDAI and SDAI and the most recent blood tests (ANA ENA FR anti CCP anti DNA ESR CRP C3 C4) were recorded; hands and wrists X-ray were performed according to good clinical practice. <h3>Results</h3> Fifty females were enrolled. Clinical characteristics during the disease course and serological and clinimeric scores at the time of enrollement are reported in Table 1. Group 1: US detected synovitis (grade 1–3) in 7 (35%) patients, mainly wrists and hands, Group 2: US detected synovitis (grade 1–3) in 5 (26.3%) patients mainly hands, elbows and wrists. Group 3: US detected synovitis (grade 1–3) in 7 (63.7%) patients, mainly knees elbows Achilles tendon, hands. <h3>Conclusion</h3> Our study confirmed that the musculoskeletal involvement in SLE is underestimated. Although not statistically significant, the groups showed differences in synovitis involvement. The percentage of asymptomatic patients with ultrasound signs of synovitis, especially of the hands and wrists, is higher than expected and almost comparable with symptomatic arthralgia patients. No association with clinimetric and laboratory tests were highlighted. As expected, the group of patients with known arthritis more frequently had ultrasonographic changes and signs of systemic disease activity.Our study suggests how necessary and interesting it is to prospectively evaluate in the future how the joint disease will progress in asymptomatic patients, and who will develop, for example, bone erosions or Jaccoud's arthropathy. <h3>References</h3> [1]Ball EM, Bell AL. Rheumatology (Oxford) 2012; 51: 771–779 [2]Piga M et al. Semin Arthritis Rheum 2016; 46: 217–224. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.